title: Working alliance development in occupational therapy: a cross-case analysis.
abstract: BACKGROUND
  Despite reverence afforded the therapeutic relationship construct in occupational therapy, many occupational therapists feel ill equipped to use themselves therapeutically to enhance the relationship with their clients. Furthermore, although occupational therapists often link the strength of the therapeutic relationship to therapy outcomes, related occupational therapy specific research has been limited. According to the psychotherapy literature, the working alliance is one element of the therapeutic relationship which has in fact been linked to therapy outcomes.
  
  
  METHODS
  A mixed-methods, prospective, multiple case study approach was used to compare the experiences of the working alliance by both occupational therapists and clients across four therapeutic dyads.
  
  
  RESULTS
  Several key elements were identified in this study's qualitative data as shaping the process of alliance development in occupational therapy including: the fostering of an interpersonal connection; the use of humour as therapeutic modality; an impetus to act that leads to functional enhancements; a shared sense of success and a positive feedback mechanism created through successfully attaining clearly delineated, client-centred therapy goals.
  
  
  CONCLUSIONS
  By considering these identified elements, occupational therapists may focus upon tangible considerations towards enhanced therapeutic use-of-self in the development of sound working alliance with their clients potentially improving therapy outcomes.
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Tricia L
authors.initials: TL
authors.lastname: Morrison
authors.forename: J David
authors.initials: JD
authors.lastname: Smith
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D009042:Motivation; D009788:Occupational Therapy / Q000379:methods* / Q000523:psychology*; D010043:Outcome and Process Assessment, Health Care; D011369:Professional-Patient Relations; D011446:Prospective Studies; D020377:Self Efficacy; D014925:Wit and Humor as Topic
keywords: professional-patient relations; therapeutic processes